MEDICARE: UNIVERSITY MUSLIM MEDICAL ASSOCIATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1114602406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY MUSLIM MEDICAL ASSOCIATION INC

Provider Business Mailing Address
First Line	:	711 W FLORENCE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-6105
Country	:	US
Telephone Number	:	323-789-5610
Fax Number	:

Provider Business Practice Location Address
First Line	:	10110 JUNIPER ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90002-3166
Country	:	US
Telephone Number	:	323-789-5610
Fax Number	:	323-789-5616

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	ALFREDO REYNOSO
Credential	:
Telephone Number	:	323-313-5588

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	05/23/2024

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